Other racial/ethnic groups have seen consistent declines in the rates of deaths from these lung, prostate, breast, and colorectal cancers, but American Indian/Alaska Native (AI/AN) populations have not. Surgical intervention is the only curative treatment for lung, breast, and colorectal cancers, and commonly used for prostate cancer. The earlier that treatment occurs in the progression of cancer, the greater the chance for survival. Some investigators have attributed the high rates of cancer mortality among AI/ANs to diagnosis at late stages of disease, geographic barriers, and alternative belief systems that impede the receipt of effective, standard cancer. Despite striking inequities in cancer survival, the factors producing these disparities remain poorly understood and incompletely described. In our first set of studies, we examine diverse factors influencing national disparities in surgical care by using 2 datasets: the National Cancer Institute's Surveillance Epidemiology and End Results (SEER), and a linkage of SEER to Medicare's Part A and Part B files. In the second set of studies, we describe community-level variation in the use of best practices related to surgical cancer care, using a detailed, prospectively gathered clinical dataset derived from the Surgical Care and Outcomes Assessment Program (SCOAP). This effort is a novel statewide surveillance and benchmarking system for surgeons, linking performance data to active interventions aimed at improving quality. In the third ethnographic study, we interview cancer patients, and surgeons about their perceptions of cancer care. Thus, our specific aims are to 1) Describe nationwide variation in processes and outcomes of surgical cancer care between AI/AN and non-hispanic White cancer patients by using SEER and SEER-Medicare datasets; 2) Compare receipt of best practices and stage-specific outcomes in the delivery of surgical care between these 2 groups of patients across Washington State's SCOAP network. 3) Describe the perceptions, attitudes, and beliefs of AI/AN patients related to surgical cancer care, and assess surgeons' cultural competence and perceptions about barriers to providing cancer care to AI/AN patients. This effort will highlight the points where breakdowns in the care of AI/AN cancer patients occur, and along with the ethnographic data, suggest how culturally tailored intervention can reduce inequities..